Compression neuropathy of the motor branch of the median nerve caused by palmar ganglion

We describe a palmar ganglion producing paralysis of the motor branch of the median nerve; such a case has not been reported previously. Ultrasonography was useful for preoperative diagnosis.     

Compression neuropathy of the superficial branch of the radial nerve. Case reports.

We present two cases of hypoaesthesia over the dorsal radial aspect of the hand with an associated painful mass in the wrist. At operation a dorsal wrist ganglion was compressing the superficial branch of the radial nerve at the anatomical snuff-box. After removal of the ganglion the hypoaesthesia was relieved.     

Compression of the motor branch of the median nerve by the superficial palmar branch of the radial artery

A case of isolated thenar wasting caused by a large superficial palmar branch of the radial artery is reported.     

The effect of blocking radial abduction on palmar abduction strength of the thumb

The measurement of palmar abduction strength of the thumb (PAST) is often used as a research tool to provide an objective assessment of thenar muscle function in patients with carpal tunnel syndrome (CTS). The purpose of this study is to determine the effect of blocking radial abduction on PAST in a normal population. PAST was measured for both hands of 100 healthy volunteers in two positions. In the first position a vertical board was placed perpendicular to the radial border of the hand to block radial abduction, and in the second position PAST was measured without the board. Men had greater PAST. There was no difference in PAST between the dominant and non-dominant hand for both men and women, when a vertical board was used. Without the board, the values were significantly greater in the dominant hand. Radial abduction should be blocked during measurement of PAST.     

Compression of the palmar cutaneous nerve by ganglions of the wrist

Two cases of compression of the palmar cutaneous nerve by ganglion of the wrist are presented. The anatomy of the region, compression factors, mechanism and clinical features are discussed. Timely surgical removal of compression is recommended.     

Isolated compression neuropathy of the palmar cutaneous branch of the median nerve

A case of isolated thenar numbness, with an associated painful palmar wrist mass is presented. At operation, a palmar wrist ganglion compressing the palmar cutaneous branch of the median nerve was encountered. After ganglion excision the numbness in the palm was relieved, and there was no recurrence at 6 years follow-up.     

Compression neuropathy of the cubital nerve at the elbow]

Compression neuropathy of the ulnar nerve at the elbow has numerous known etiologies, and the anatomy of the ulnar nerve around the elbow leaves it vulnerable to compression at numerous sites. The compression may be extrinsic such as in occupational neuropathy or in cases of postanesthesia neuropathy. The so-called idiopathic compression may be favored by some anatomic variations. The cubital tunnel retinaculum may be loose, leading to ulnar nerve dislocation or subluxation or tight compression of the nerve during flexion of the elbow. Bulging of the synovium in the floor of the tunnel may be the cause of compression in rheumatoid arthritis, whereas osteophytes may be the cause in degenerative osteoarthritis. Cubitus valgus or instability due to a pseudarthrosis of the lateral epicondyle or to ligamentous injury may stretch the nerve. The choice of a surgical technique must be based on (i) the pathophysiology of chronic nerve compression at the elbow, (ii) an understanding of the etiology of the nerve compression in the particular patient's case, and (iii) the knowledge of the potential technical drawbacks of the various operative procedures. Simple decompression is the first choice in case of minimal compression without instability of the nerve. Decompression of the nerve with a medial epicondylectomy is indicated in case of instability of the nerve and is the first choice in case of pseudarthrosis or malunion of the medial epicondyle. Ulnar nerve transposition is technically the most demanding procedure. Inadequate surgical technique creates new sites of compression.(ABSTRACT TRUNCATED AT 250 WORDS)     

Compression neuropathy of the radial nerve as a complication of elbow arthroscopy: A case report and review of the literature

Arthroscopic surgery of the elbow was performed in a 14-year-old male athlete for diagnosis and treatment of osteochondritis dissecans of the capitellum. Anterolateral and anteromedial portals were used in accordance with described technique. Postsurgical examination revealed an immediate and complete palsy of the posterior interosseous nerve. This complication was attributed to the manipulation of the arthroscope and instrumentation in close proximity to the radial nerve. Neuromuscular function returned to normal over a 6-month period. This case demonstrates the importance of portal placement and instrument manipulation in arthroscopic evaluation and treatment of the elbow. Further study is necessary to develop technical and procedural improvements to assure safe and effective arthroscopic treatment.     

Compression neuropathy of the common peroneal nerve caused by a ganglion

A case of compression of the common peroneal nerve caused by a ganglion herniating from the superior tibio-fibular joint is reported. MR imaging was partially helpful in making the diagnosis. The patient has made an almost complete recovery 3 months after excision of the lesion. Early diagnosis and treatment is required to ensure recovery.     

Compression neuropathy of the peroneal nerve secondary to a ganglion cyst

Peripheral neuropathies caused by ganglion cysts are rare, particularly in the lower extremities. The case of a 45-year-old man with a two-month history of foot drop and swelling in the region of the right fibular head is presented. Physical examination and electromyogram studies verified a peroneal nerve palsy. Magnetic resonance imaging revealed a lobulated, multilocular, cystic-appearing mass extending around the fibular neck. Surgical decompression of the nerve with removal of the mass and careful articular branch ligation was performed. Surgical pathology reports confirmed the diagnosis of a ganglion cyst. The patient regained full function within four months of the decompression. Pertinent findings on physical examination are discussed, as well as electromyogram and magnetic resonance imaging results. If symptoms persist, early surgical decompression (between the third and fourth months) is recommended.     

Compression neuropathy of the median nerve during tissue expansion of the forearm

Acute median nerve compression usually occurs from increased pressure within the compartments. During tissue expansion of the forearm, the interstitial pressure increases, which usually decreases following the relaxation of tissue. Clinical diagnosis of acute neuropathy is usually made from the history and clinical signs and symptoms. The cases of two patients who developed acute symptoms of neuropathy during tissue expansion of the forearm are presented.     

Reconstruction of the thumb tip using palmar neurovascular flaps

Objective

Reconstruction of the tip of the thumb using a neurovascular flap.

Indications

Transverse defects of the thumb??s tip or large defects of the palmar pulp (max. 2.0?C2.5?cm) with exposure of bone and/or tendons.

Contraindications

Extensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (>?2.0?C2.5?cm finger length), circumferential soft tissue defects, and previous defects/operations (relative).

Surgical technique

Supine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap??s base (O??Brien). Finally, closure of the defect at the flap??s base using a full thickness skin graft, Z plasty, or V-Y plasty.

Postoperative management

Plaster cast (finger slightly flexed) for 2 weeks.

Results

Reliable method. Good functional results with good sensibility and only minor reduction in range of motion.     

Entrapment neuropathy of the palmar cutaneous branch of the median nerve by the fascia of flexor digitorum superficialis

A case of thenar numbness, with concomitant carpal tunnel syndrome is presented. Physical findings and the result of injection of a local anesthetic into two different sites of tenderness suggested coexistence of entrapment and/or compression of the palmar cutaneous branch of the median nerve and the main trunk of the median nerve at the carpal tunnel. At operation, constriction of the palmar cutaneous branch of the median nerve by the fascia of seemingly normal flexor digitorum superficialis was observed beneath the site of maximum tenderness. After decompression of this nerve, combined with carpal tunnel release, the patient lost all pain and numbness; there was no recurrence at 5 months follow-up.     

A palmar cross-finger flap for coverage of thumb defects

We have devised a method of covering tissue defects of the distal thumb using a flap elevated between the two flexion creases on the palmar skin over the proximal phalanx of the long finger. The advantages of this method over the usual dorsally based, distal, cross-finger flap include improved appearance of the donor finger, comfortable positioning, and avoidance of joint contractures. Although sensitivity of the palmar scar, contractures, or other disadvantages of this approach were sought during follow-up, none were found.     

Compression neuropathy of the median nerve caused by a loose body in the elbow

We present a case of median nerve compression at the elbow associated with an intra-capsular loose body cured by arthroscopic removal of the loose body. This is a rare but eminently treatable cause of median nerve compression.     

Ligament replacement in palmar instability of the MP joint of the thumb

Surgical Principles In posttraumatic or habitual palmar instability of the MP joint of the thumb the deficiency of the ligaments is compensated by an increase in flexor tonus and a tenodesis to prevent hyperextension. The flexor tonus is increased by transferring the radial sesamoid bone together with the deep head of the flexor pollicis brevis to the base of the proximal phalanx. The tendinous portion of this muscle is sutured to the remaining ligaments and the abductor pollicis brevis with the MP joint in extension to form a tenodesis. Thus hyperextension is passively blocked. Revised Version from: Operat. Orthop. Traumatol. 2 (1990), 256–262 (German Edition).